Transcript 2011: Slideshow - Health & Social Care Information Centre

The National Mastectomy and Breast
Reconstruction Audit
Key findings of the Fourth Annual Report
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011
Audit aims
• To describe provision of mastectomy and breast
reconstruction services in England
• To investigate determinants and outcomes of
care for women with breast cancer having a
mastectomy with or without breast
reconstruction
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011
Audit methodology
• The Audit prospectively enrolled:
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women with breast cancer
who underwent mastectomy or breast reconstruction surgery
in the NHS and independent sector in England
between 1 January 2008 and 31 March 2009
• Data collected from:
– clinicians on clinical practice and inpatient outcomes
– patients on treatment options, patient-reported outcomes and
experience of care
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010
Audit participation – clinical study
• 18,216 women with complete information:
– 16,558 treated at English NHS trusts
– 1,249 treated at independent hospitals
– 409 treated at non-English NHS trusts that also chose to
participate
• Overall NHS case ascertainment of 81.4%
• More than two thirds of NHS trusts achieved over 75%
case ascertainment
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011
Audit participation – PROMs study
• 10,623 women asked to participate
– 8,725 (82%) gave their consent
• 8,159 women sent 3 month questionnaires
– 6,882 (84%) returned a completed questionnaire
• 8,536 women sent 18 month questionnaires
– 7,110 (83%) returned a completed questionnaire
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011
Fourth Annual Report
Provides data on:
• Patient characteristics and patterns of care
• Patient-reported experience, information
provision and reconstructive choices
• Patient quality of life 18 months after surgery
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011
High levels of patient satisfaction
• Over 90% of women were very satisfied with the
competence of their consultant surgeon
- 92% of mastectomy only patients
- 96% of immediate reconstruction patients
- 96% of delayed reconstruction patients
• 85% of women were very satisfied with the
professionalism of the clinical team
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011
Recommendation 1
•
NHS trusts and independent hospitals should
act to maintain the current high levels of
satisfaction with both consultant surgeons and
breast cancer teams.
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011
Patient decision making and concerns
• Very satisfied that their consultant surgeon involved them in the
decision making process
- 75% of mastectomy only patients
- 81% of immediate reconstruction patients
- 87% of delayed reconstruction patients
• Very satisfied that their consultant surgeon was available when
they had concerns
- 69% of mastectomy only patients
- 75% in the immediate reconstruction patients
- 76% in the delayed reconstruction patients
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011
Recommendation 2
•
NHS trusts and independent hospitals should
ensure that women are able to be involved in
decision making to the degree that they wish,
and that staff are available to address the
concerns of women undergoing cancer
treatments and complex reconstructive
procedures.
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011
Informing patients of what to expect
• A few examples:
– Around one fifth of reconstruction patients were not
satisfied with the size of their reconstructed breast in
comparison to their unaffected breast
– Three quarters of IR and four fifths of DR patients
were satisfied or very satisfied with how their
abdomen looked following TRAM/DIEP flap
reconstruction
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011
Recommendation 3
•
Clinicians should use the summary of the
experiences of women undergoing breast
reconstruction collected during the Audit to
augment information about outcomes obtained
from volunteers whose background, cancer
treatments and age may differ significantly
from the woman making reconstructive
decisions.
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011
Levels of emotional and sexual wellbeing
• Feel confident in a social setting most or all of the time
18 months after surgery
– 77% of mastectomy only patients
– 85% of immediate reconstruction patients
– 92% of delayed reconstruction patients
• Feel sexually attractive when clothed most or all of the
time 18 months after surgery
– 37% of mastectomy only patients
– 57% of immediate reconstruction patients
– 68% of delayed reconstruction patients
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011
Recommendation 4
•
Clinicians should inform women undergoing
mastectomy that those who underwent breast
reconstruction reported higher levels of
emotional and sexual well being than those
who underwent mastectomy alone.
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011
Sufficient reconstructive information and
choices
• In those having delayed reconstruction, higher levels of
satisfaction with breast area appearance and sexual wellbeing
were attained following free flap reconstruction compared to
pedicle flap reconstruction with or without an implant.
• Both groups reported greater satisfaction than the group that
had delayed implant-only reconstruction
• In those having immediate reconstruction, levels of satisfaction
with breast area appearance and emotional and sexual
wellbeing following pedicle or free flap reconstruction were
greater than those following implant only reconstruction
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011
Recommendation 5
•
NHS trusts and independent hospitals should
act to ensure that women in both the
immediate and delayed reconstruction settings
are provided with sufficient information and
choices about the full range of reconstructive
options.
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011
Overall results of surgery at 18 months
• Proportion that rated the overall results as excellent or
very good:
– 73% of mastectomy only patients
– 67% of immediate reconstruction patients
– 78% of delayed reconstruction patients
• Proportion that were satisfied or very satisfied with how
they looked in the mirror clothed:
– 83% of mastectomy only patients
– 90% of immediate reconstruction patients
– 93% of delayed reconstruction patients
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011
Recommendation 6
• NHS trusts and independent hospitals should
ensure that they continue to attain the excellent
results of mastectomy and breast reconstruction
surgery reported by patients.
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011
Benchmarking using national results
• The Audit has established local and national
baselines for patient satisfaction and quality of
life outcomes following mastectomy and breast
reconstruction surgery
• Hospital organisations should refer to their own
results, the national average, and the outcomes
of high performing organisations in evaluating
the care they deliver in future
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011
Recommendation 7
• The Audit findings represent the first national data of
their type, and should be used by NHS trusts and
hospital organisations to define a performance
benchmark against which their future outcomes may
be compared.
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011
High achieving organisations in the
Audit
• A number of organisations were found to have
results that were significantly better than the
national average for particular aspects of care
quality and outcomes
• The results attained at these organisations
demonstrate what is achievable, and should be
used to help set future targets for care quality
and outcomes
Recommendation 8
• Those involved in the development of future guidelines on
mastectomy and breast reconstruction should refer to the
results of high achieving organisations when setting
benchmarks for future audit.
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011
Thank you for your support and
participation!
The four annual reports are available for download at www.ic.nhs.uk/mbr
Please e-mail [email protected] or call 0113 254 7139
for any general queries or for copies of the Audit reports
Please e-mail [email protected] if you have any methodological queries
or would like to use the RCS patient questionnaires for audit or research
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011